RIGHT TO EXAMINE CONTRACT. We want You to be satisfied with the contract You have purchased. We urge You to closely examine its provisions. If for any reason You are not satisfied with Your purchase, You may cancel the contract by returning the contract within ten days after You receive it. A written request for cancellation must accompany the contract. In such event, We will pay You an amount equal to the sum of (i) the difference between the premiums paid and the amounts allocated to any Account under the contract and (ii) the Contract Value on the date of surrender. You bear only the investment risk during the period prior to Our receipt of request for cancellation. Signed for the Company [ ] Premium Payments are flexible as described herein. NONPARTICIPATING ALL PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT, WHEN BASED ON INVESTMENT EXPERIENCE OF A SUB-ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNT. DETAILS OF THE VARIABLE PROVISIONS ARE DESCRIBED UNDER VALUATION PROVISIONS, PAGES 6 AND 7. HL-VA03 Printed in U.S.A. B644R0.FRM TABLE OF CONTENTS Page Contract Specifications 3 Definition of Certain Terms 4 Premium Payments 6 Valuation Provisions 6 Transfers Between Accounts 7 Contract Control Provisions 8 General Provisions 9 Surrenders 10 Death Benefits 11 Settlement Provisions 14 Annuity Tables 16 HL-VA03 Page 2 Printed in U.S.A. B645R0.FRM CONTRACT SPECIFICATIONS CONTRACT NUMBER [ SPECIMEN ] CONTRACT ISSUE DATE [SEPTEMBER 14, 2009 ] NAME OF ANNUITANT [ XXXXX XXXXX ] ANNUITY COMMENCEMENT DATE [ JANUARY 1, 2039 ] ANNUITANT AGE [ 35 ] INITIAL PREMIUM PAYMENT [ $2,000 ] ANNUITANT GENDER [ MALE ] MINIMUM SUBSEQUENT PAYMENT [ $500 ] CONTINGENT ANNUITANT [ XXXX XXXXX ] DESIGNATED BENEFICIARY [ XXX XXXXX ] CONTRACT OWNER [ XXXXX XXXXX ] DESCRIPTION OF BENEFITS INDIVIDUAL FLEXIBLE PREMIUM VARIABLE ANNUITY CONTRACT SEPARATE ACCOUNT: [ HARTFORD LIFE INSURANCE COMPANY SEPARATE ACCOUNT SEVEN ] MORTALITY AND EXPENSE RISK CHARGE: [0.50%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ADMINISTRATION CHARGE: [0.20%] PER ANNUM OF THE DAILY SUB-ACCOUNTS VALUE. ANNUAL MAINTENANCE FEE: $[0] IF THE CONTRACT VALUE IS [$50,000] OR MORE ON THE CONTRACT ANNIVERSARY. [$50] IF THE CONTRACT VALUE IS LESS THAN [$50,000] ON THE CONTRACT ANNIVERSARY AND WHEN THE CONTRACT IS FULLY SURRENDERED. PREMIUM BASED CHARGE: WE WILL APPLY AN ANNUAL PREMIUM BASED CHARGE AGAINST EACH PREMIUM PAYMENT MADE TO THIS CONTRACT. THE PREMIUM CHARGE WILL APPLY TO EACH PREMIUM PAYMENT THAT HAS BEEN INVESTED FOR [...
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or the gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3031-99 TABLE OF CONTENTS SPECIFICATONS DEFINITIONS OWNER, ANNUITANT AND BENEFICIARY THE ACCUMULATION PHASE PAYMENTS VALUES TRANSFER XXXXXXXXXX AND SURRENDER DEATH BENEFIT THE PAYOUT PHASE ANNUITY BENEFIT TRANSFER WITHDRAWAL PRESENT VALUE OF ANNUITY BENEFIT PAYMENTS DEATH OF THE ANNUITANT ANNUITY BENEFIT PAYMENT OPTIONS ANNUITY BENEFIT PAYMENT GUARANTEE OPTIONS ANNUITY OPTION TABLES GENERAL PROVISIONS Form A3031-99
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund the greater of the above or gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefit payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. /s/ Xxxxxxx X. Xxxxxx /s/ Xxxxxxx X. Xxxxxx President Secretary Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating Form A3036-01 1 BACS11 TABLE OF CONTENTS SPECIFICATIONS ............................................................. 3 DEFINITIONS ................................................................ 9
RIGHT TO EXAMINE CONTRACT. You may return this contract within 90 days after you have received it. It can be mailed or delivered either to us or the representative who sold it. If you return the contract within 10 days after you have received it ("the Free Look Period"), we will refund the Single Purchase Payment less the total amount of all annuity payments made or withdrawals taken. If you return the contract after the expiration of the "Free Look Period" but within 90 days after the Issue Date, we will pay to you the Contract Value on the date the contract is returned to us plus any premium tax deducted on the Issue Date. FIRST ALLMERICA FINANCIAL LIFE INSURANCE COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 Phone Number: 0-000-000-0000 This is a legal contract between you and the Company and is issued in consideration of the Single Purchase Payment shown on the Specifications page. The Net Payment may be allocated to the Fixed Income Option or the Variable Income Option or a combination of both. If you select the Variable Income Option, you can allocate the Net Payment among the Variable Sub-Accounts. Single Payment Immediate Variable and Fixed Annuity Annuity Payments Payable on the Annuity Income Date Death Benefit Payable if an Owner or an Annuitant Dies prior to Annuity Income Date This contract does not participate in the profits or surplus of the Company FORM A3029-99-GRC TABLE OF CONTENTS SPECIFICATIONS............................................................... 3
RIGHT TO EXAMINE CONTRACT. Within 10 days of the date of receipt of a Certificate under this Contract by a Certificate Owner, it may be returned by delivering or mailing it to the Company at its Administrative Office. When the Certificate is received by the Company, it will be voided as if it had never been in force. The Company will refund the Certificate Value computed at the end of the Valuation Period during which the Certificate is received by the Company at its Administrative Office. THIS IS A LEGAL CONTRACT BETWEEN THE OWNER AND THE COMPANY READ YOUR CONTRACT CAREFULLY SIGNED FOR THE COMPANY AT CARMEL, INDIANA, ON THE CONTRACT DATE. ABCDEFGH ABCDEFGH SECRETARY PRESIDENT ALLOCATED FIXED AND VARIABLE GROUP ANNUITY CONTRACT NON-PARTICIPATING WITHDRAWAL VALUES AND THE DEATH BENEFITS PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE VARIABLE ACCOUNT, ARE VARIABLE AND ARE NOT GUARANTEED AS TO DOLLAR AMOUNT. NON FORFEITURE VALUES MAY INCREASE OR DECREASE BASED ON THE MARKET VALUE ADJUSTMENT SPECIFIED IN THIS CONTRACT. TABLE OF CONTENTS CONTRACT SCHEDULE............................................................4 DEFINITIONS..................................................................7
RIGHT TO EXAMINE CONTRACT. This Contract may be returned for cancellation within days after the date it is received by the Owner. It may be delivered or mailed to the Company or to any agent of the Company, along with a written request for cancellation. This Contract shall then be canceled and the Company shall refund to the Owner an amount equal to: (a) all contributions allocated to the Interest Accumulation Account, with no deductions; plus (b) the value on the surrender date of all contributions allocated to any Investment Fund. For purposes of this paragraph only, the surrender date shall be the date this Contract is delivered or mailed to the Company, along with the request for cancellation. This Contract is issued in consideration of the application for this Contract and payment of the first contribution (premium). Additional contributions may be made at any time prior to the Annuity Commencement Date or the death of the Owner. Each contribution is subject to the Contributions provision of this Contract. This Contract shall take effect on the Effective Date shown in the Specifications Section of this Contract. This Contract is executed by the Company at its Home Office in New York, New York on the Date of Issue shown in the Specifications Section of this Contract. Vice President Chairman, President and Chief Executive Officer AMOUNTS HELD IN CONNECTION WITH THIS CONTRACT MAY BE HELD IN THE COMPANY’S GENERAL ACCOUNT AND/OR THE COMPANY’S SEPARATE ACCOUNT THAT THE COMPANY MAINTAINS IN CONNECTION WITH THIS CONTRACT AND CERTAIN OTHER CONTRACTS. THE AMOUNTS HELD IN THE SEPARATE ACCOUNT ARE NOT GUARANTEED AS TO FIXED DOLLAR AMOUNTS AND SHALL INCREASE OR DECREASE IN VALUE BASED UPON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. A DESCRIPTION OF THE SEPARATE ACCOUNT APPEARS IN THE ACCOUNTS SECTION OF THIS CONTRACT. A DESCRIPTION OF THE CHARGES DEDUCTED FROM THE AMOUNTS HELD IN THE SEPARATE ACCOUNT APPEARS IN THE DEFINITION OF ADMINISTRATIVE CHARGES IN THE DEFINITIONS SECTION OF THIS CONTRACT. THIS IS A PARTICIPATING CONTRACT. IRA-2004 This page left blank intentionally. IRA-2004 Table of Contents SECTION 1 - SPECIFICATIONS 5 SECTION 2 - DEFINITION 5 Account Value 5 Administrative Charges 5 Annuitant 5 Annuity Commencement Date 6 Beneficiary 6 Business Day 6 Code 6 Commuted Value 6 Contract 6 Current Rate of Interest 6 Date of Issue 6 Effective Date 6 Guaranteed Rate of Interest 6 Home Office 6 Interest Accumulation Account 6 Investment Fund 6 Notice 7 Owner 7 Required Distribution D...
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this contract by returning it to the Company or one of its authorized representatives within ten days after receipt. If returned, the Company will refund an amount equal to the Accumulated Value, after application of any Market Value Adjustment, plus any fees or other charges imposed and less any Payment Credits. These values are determined as of the date the contract is returned to the Company. If, however, the contract is issued as an Individual Retirement Annuity (IRA), the Company will refund gross payments. ALLMERICA FINANCIAL LIFE INSURANCE AND ANNUITY COMPANY Home Office: Dover, Delaware Principal Office: 000 Xxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxxxxxx 00000 This is a legal contract between Allmerica Financial Life Insurance and Annuity Company (the Company) and the Owner and is issued in consideration of the Initial Payment shown on the Specifications page. Additional Payments are permitted. Payments may be allocated to Variable Sub-Accounts, the Fixed Account or Guarantee Period Accounts. While this contract is in effect, the Company agrees to pay annuity benefits payments beginning on the Annuity Date or to pay a Death Benefit to the Beneficiary if an Owner dies prior to the Annuity Date. Flexible Payment Deferred Variable and Fixed Annuity Annuity Benefit Payments Payable on the Annuity Date Death Benefit Payable to Beneficiary if Owner Dies prior to Annuity Date Non-Participating FORM A3028-99 TABLE OF CONTENTS SPECIFICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 DEFINITIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this Contract for any reason without penalty within 10 days after the date the Owner received it (30 days if this is a replacement Contract). Simply return it to Our Administrative Office or to the financial professional through whom it was purchased. Canceling this Contract will void it from the beginning and upon cancellation, We will refund the Contract Value as of the Valuation Date on which We receive the cancellation Request. ALL CONTRACT VALUES AND BENEFITS PROVIDED BY THIS CONTRACT ARE VARIABLE, MAY INCREASE OR DECREASE BASED IN PART ON THE VALUE OF AN EXTERNAL INDEX AND ARE NOT GUARANTEED AS TO A FIXED DOLLAR AMOUNT. WHILE THE VALUES AND BENEFITS OF THIS CONTRACT MAY BE AFFECTED BY THE EXTERNAL INDEX, THIS CONTRACT DOES NOT DIRECTLY PARTICIPATE IN ANY STOCK OR EQUITY INVESTMENTS. Signed for The Lincoln National Life Insurance Company at Our Home Office. TABLE OF CONTENTS PROVISIONS Page Number CONTRACT SPECIFICATIONS 3 DEFINITIONS 4 GENERAL PROVISIONS 6 CONTRACT VALUE 8 INDEXED ACCOUNTS 8 REALLOCATIONS 9 WITHDRAWALS 10 ADVISORY FEE WITHDRAWALS 10 SURRENDERS 10 DEATH BENEFITS 11 BENEFICIARY 13 ANNUITY PAYMENT OPTIONS 13
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this Contract for any reason without penalty within 10 days after the date the Owner received it (30 days if this is a replacement Contract). Simply return it to Our Administrative Office or to the financial professional through whom it was purchased. Canceling this Contract will void it from the beginning and upon cancellation, We will refund the Contract Value as of the Valuation Date on which We receive the cancellation Request. All benefits and values provided by this Contract are based on the investment experience of a Separate Account. These benefits and values are variable and may increase or decrease and are not guaranteed as to a fixed dollar amount, unless otherwise specified.
RIGHT TO EXAMINE CONTRACT. The Owner may cancel this Contract for any reason without penalty within 10 days after the date the Owner received it (30 days if this is a replacement Contract). Simply return it to Our Administrative Office or to the financial professional through whom it was purchased. Canceling this Contract will void it from the beginning and upon cancellation, We will refund the Contract Value as of the Valuation Date on which We receive the cancellation Request plus any fees or charges We deducted. All benefits and values provided by this Contract are based on the investment experience of a Separate Account. These benefits and values are variable and may increase or decrease and are not guaranteed as to a fixed dollar amount, unless otherwise specified.
